Reconstruction of circumferential hypopharyngeal defect after tumor - - PowerPoint PPT Presentation

Ching-Hsiang Yang, Johnson Chia-Shen Yang

Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital

Reconstruction of circumferential hypopharyngeal defect after tumor ablation with lateral thigh flaps: the Omega design

Nothing to disclose

Tubular hypopharyngeal defect reconstruction choices

• Pectoralis major flap
• Gastric pull-up
• Free jejunal flap
• Free radial forearm flap
• Free anterolateral thigh flap

Introduction

The disadvantages for these above-mentioned flaps:

• Fixed lumen on both ends (mis-matched lumen)
• No spare tissue for use

Cervical esophagus Lumen mismatch

Flap

Object of this study

To investigate the feasibility of Omega flap design to improve luminal mismatch for tubular hypopharyngeal defect reconstruction.

Patients and Method

Sep 2009~ April 2014

• 63 free flaps for hypopharyngeal reconstruction
• Patch 40; Tubing 10
• Omega flap tubing 13 (12 M, 1 F)

Omega Design (1)

hypopharyngeal defect length = flap width

Omega Design (2)

Excessive flap tissue

Omega flap Design (3)

Perfect Lumen match Spare flap tissue De-epithelialized for double-breasted stitching inner stitch

• uter stitch

Omega flap Design (4)

Double-breasted stitching Excessive flap tissue for Neck skin defect Spare flap tissue for neck skin defect reconstruction prn

Results

• All flaps survived
• Donor site STSG: 6/13
• Wound infection rate: 30.8%
• Fistula rate: 38.5%
• Surgical debridement: 5/12 (41.7%)
• Secondary reconstruction: Internal mammary artery flap

(1)

Discussion (1)

Advantages: Omega Design

• Allows exact luminal match on both ends for smooth

passage

• Easier inset
• Excessive flap tissue for:
• Dead space
• Double-breasted stitching
• Neck skin defect reconstruction

Discussion (2)

Disadvantages: Omega design

• Slightly longer ischemic time
• ALT donor site STSG (50%)
• Double-breasted stitch is directly under neck

skin incision line (10/12)

10 2

Discussion (3)

• Fistula rate(38.5%); Wound infection rate (30.8%)
• Possible causes:
• Pre-op CCRT: 12/13 (92.3%)
• Poor nutritional status (4 pre-op gastrostomy)
• Huge wound
• Suturing technique ?

Fistula: 9-33%. Wound complications: 25% Yu et al. Cancer. 2010 Apr 1;116(7):1718-24 Clark et al. Laryngoscope. 2006 Feb;116(2):173-81.

Discussion (4)

Flap comparison Laryngo- esophagus cervico- esophagu s Double- Breasted stitch Spare tissue Jejunal flap

too small matched no no

Radial forearm flap

matched too big no no

ALT flap (Spiral)

matched too big no no

ALT flap (Omega)

matched matched yes yes

Conclusion

• The quest for a perfect flap to reconstruct tubular

hypopharyngeal defect continues.

• This Omega flap design offers an alternative choice to

enhance patient outcome.

• More case number and long term f/u is needed.